A
history of failure
Author and psychologist Bruce Levine
pummels psychiatry, psychotropic drugs
and the role both may have played in the
case of Andrea Yates.
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By Amy Benfer

July
11, 2001 | In the 19th century, a woman who experienced depression
or discontent was likely to be diagnosed as "neurotic" and subjected
to treatment ranging from vibrators (to induce orgasm) to clitoridectomy
(to ensure that she never had another one again), with various
talk, drug and institutional therapies in between. In the 1950s,
a neurotic woman might find herself undergoing electroshock therapy,
or, if she was lucky, she might be offered the sedation of Valium.
Today, the depressed housewife is likely to find herself on one
of the new antidepressants such as Prozac, Zoloft, Paxil or Wellbutrin.

Andrea
Yates, a reportedly depressed housewife, had, in the years before
she killed her five children, been treated with various drugs,
including Wellbutrin, Effexor and Haldol. According to her husband,
Yates suffered from postpartum depression. According to Bruce
E. Levine, Ph.D., author of "Commonsense Rebellion: Debunking
Psychiatry, Confronting Society -- An A to Z Guide to Rehumanizing
Our Lives," the combination of medicines that Yates reportedly
took, particularly if she was taking them at the same time, may
well have been a prescription for a tragic psychotic break.

We
often think of the history of psychiatry as a story of progress,
an evolution from barbaric and invasive treatments to more sophisticated,
humane care based on sound scientific principles. And while it
certainly seems like progress to move from attacking depression
with scalpels and electrodes to treating it as a chemical imbalance
with medication, in high-profile cases like those of Andrea Yates
and Columbine High School's Eric Harris, who was also being treated
with antidepressants, critics like Levine have serious questions
about the efficacy and safety of these medications. Levine, a
practicing psychologist for more than 15 years, believes it would
be rash and reductive to lay the blame for Yates' and Harris'
homicidal impulses at the feet of American pharmaceutical companies.
But if we are going to treat depression -- and postpartum psychosis,
anorexia, oppositional defiant disorder, premenstrual syndrome
and dozens of other illnesses -- with tools from the chemistry
set, says Levine, it is fair to ask whether we know what we are
doing at all.

Why
are we now prescribing stimulants for women who, three decades
ago, would have been put on sedatives? Is this a sign of progress,
the result of better diagnostic tools and more effective treatments?
Or is it a sign of social engineering to accommodate the changing
expectations of women in society? Are the cutting-edge psychiatric
treatments of today any less arbitrary than those of 30 or even
100 years ago? And if we don't know exactly how a medication works,
is it possible that, in rare cases, we might inadvertently give
a patient a medication that triggers a psychotic reaction?

"The
history of psychiatry is one of nearly unmitigated failure," says
Levine, who also is a member of the International Center for the
Study of Psychiatry and Psychology, an organization that educates
the public on the dangers of psychotropic drugs, electroshock
and psychosurgery, as well as argues against the idea that mental
disorders can be traced to biochemical and genetic causes.

The
theory that depression and other disorders are caused by "chemical
imbalances" in the body that can be remedied by psychotropic medication
is, according to Levine, "just that: a theory." Not only does
he believe that psychotropic medication is, at best, ineffective;
he also claims that the rush to solve social problems by medicating
individuals is blinding us to the ways in which people are rebelling
against an "institutional society" that doesn't meet human needs.

Speaking
by telephone from his home in Ohio, Levine addressed the ways
in which pharmaceutical companies romance Americans, the effects
of the mental health industry on women and children, and the possible
role of psychotropic medication in the Andrea Yates case.

(Several
days after Salon's interview with Levine, Families USA, a healthcare
consumers group based in Washington, published data showing that
last year, leading pharmaceutical companies spent more than twice
as much money on advertising, marketing and administration as
they did on research into new medicines.)

You
have written: "One of the greatest marketing feats of the past
20 years is use of pharmaceutical companies' dollars to convince
the mass media that psychiatrists who prescribe these companies'
drugs are basing their treatment on anything resembling science."
What do you mean by this?

Thirty
years ago people used to laugh at psychiatry. Since then, the
science has not advanced, but the marketing on the part of pharmaceutical
companies has. Just like any other corporation, these companies
bring out new models and new brands; when people start to notice
problems with one product, they bring out another one which may
not be any better than the last one, but its problems are less
well known. These are multibillion-dollar companies that have
made sure that professional organizations and consumer groups
hear the same line over and over again. Even lots of doctors don't
have the time to do much more than read press releases.

But
today, even mainstream psychiatry textbooks will tell you that
many of these drugs have no benefit beyond the placebo effect,
especially for children. Meanwhile, estimates are as low as half
a million to as high as 2 million children are being put on these
drugs, which may have no greater benefit than a sugar pill.

All
these new antidepressants -- Prozac, Paxil, Zoloft -- are SSRIs
[selective serotonin reuptake inhibitors]; they all increase the
level of the neurotransmitter serotonin in the brain. The theory
is that this increase fixes depression.

But
they've changed their theory every five or 10 years of which neurotransmitter
fixes depression. So if you look back 20 or 30 years, they were
talking about norepinephrine and that's why they were giving out
things like Tofranil and Elevil.

People
debate whether they decided before or after Eli Lilly came out
with Prozac that serotonin was the key for depression. Now they've
come out with Wellbutrin -- and that affects only dopamine.

Part
of the insanity of psychiatry is that not only is there no real
scientific evidence that psychotropic drugs are no better for
depression than placebos, but they certainly have a hell of a
lot more side effects than sugar pills, and they also mix these
prescriptions together -- especially Wellbutrin and Effexor --
routinely.

Psychiatry
textbooks admit that these new antidepressants are no more effective
than the older ones, but some of them do say that the side effects
are less severe. But that, also, is highly debatable.

What
are some of the side effects that people taking SSRIs can expect?

What
we know for sure is that patients who take Prozac and other SSRIs
have sexual difficulty. There is a debate as to how high these
percentages go -- but some people say it can be as high as 70
percent. Overall, what these drugs do is anaesthetize you. They
numb you. Some people like that feeling, just like some people
like to numb themselves with alcohol or other mood-altering drugs.
For them, it's like the drug soma, from "Brave New World." But
for some people, taking a drug that makes them feel less is really
scary.

For
example, I have had patients on psychiatric drugs who have had
genuine tragedy occur in their lives -- a friend dies, or something
like that -- and they have reacted with a robotic response, or
if not quite robotic, it's a little less full than it would be
otherwise. They have this basic feeling inside that nothing is
affecting them.

Another
one of the great deceptions is what the drug companies like to
call "selective serotonin." People believe that upping serotonin
only will only affect their depression. What they don't tell people
is that serotonin is everywhere in your body. So when you change
the amount of serotonin in the neurosynapses in your brain, you
are also changing it in your cerebellum, in your gastrointestinal
tract.

A
lot of people have stomach problems when they are taking these
things. It affects your sleep cycles. There is almost no part
of your body that serotonin doesn't affect. A lot of people have
withdrawal symptoms when they stop taking these drugs. That was
another initial deception: They were trying to tell people that
there would be no addiction, and no withdrawal symptoms. That's
totally not true. If you take any kind of drug that affects your
neurotransmitters, when you stop taking it, your body will have
to rebound. There are all kinds of withdrawal symptoms. Their
euphemism now is "discontinuation syndrome."

Newspapers
have told us quite a bit about the kind of psychiatric treatment
Andrea Yates was receiving. What kind of side effects might her
treatment have caused?

In
the case of Andrea Yates, according to news reports, she was getting
Wellbutrin and also another antidepressant, Effexor. The news
reports don't say if she was getting them recently, but it's clear
she was on both of them sometime in the last couple of years.
They all say she was pulled off this antipsychotic Haldol. When
people are taken off Haldol, they routinely become really agitated,
they feel completely out of control. Sometimes people can't even
keep food down; if they haven't eaten for a while, they often
experience dry heaving.

But
if you add all three of these drugs together, they were playing
with three different neurotransmitters. Here's the interesting
thing: The Wellbutrin ups dopamine, the Effexor ups the serotonin
and norepinephrine. You know what else ups all three of those?
It's called cocaine. If you want to be a one-stop shopper, just
go ahead and do cocaine. It's a little different, because cocaine
gives you a quicker hit, and these things take a little longer.

Haldol
suppresses dopamine. If they were giving her the Wellbutrin at
the same time -- which is not clear from the news reports -- they
were giving her another drug that increased it. When people hear
this sort of thing, they immediately conclude that Andrea Yates
must be the victim of malpractice. But this sort of thing happens
all the time. This is the standard of care, however illogical
it may sound.

How
do you explain something like postpartum depression? Would you
consider it a chemical imbalance triggered by a physical act in
the body, or a social phenomenon brought on by the stress of raising
a child? How best would you treat it?

Some
folks explain postpartum depression by saying that it is rooted
in hormonal changes. If that is your argument, then it would make
sense that you would want to treat it through drug therapy. But
once people have labeled it as a chemical imbalance, they start
to treat it with all these psychiatric drugs when it hasn't been
proven that serotonin is the cause of these women's problems.

Not
everyone will flip out like Andrea Yates, but for a certain percentage
of women who are particularly sensitive to these drugs, it may
increase their chances of having a psychotic break.

It's
a given that these women who are going through this are having
a really hard time. They are down, they are really hurting. The
issue is whether it is helpful to create a syndrome for it. For
some people, it may make them feel better to know that there is
a name for what they are going through, and it may make it easier
for them to explain their condition to other people.

The
downside is not just the drugs and the side effects; it's also
that these people are missing out on what human beings are supposed
to be doing when they are going through this kind of situation.
The No. 1 thing they should be doing is supporting each other
emotionally -- validating each other's feelings, building some
real trust among people. When you help someone get through a hard
time, that's how you build strong bonds and families and communities.

People would rather numb themselves with drugs than admit that
we live in a pretty weird society, one in which no one is really
around to physically help these women who find themselves suddenly
the only person in charge of this kid. Their husband is off at
work, their friends have jobs. For some people, that can be a
pretty crazy situation. For 99.9 percent of the history of the
human race, no one ever raised a kid in that manner. When a child
was born, the mother could find plenty of emotional and physical
support, and the burden was not resting entirely on one person.

Over
the last years, we have seen a huge increase in the number of
syndromes. The DSM [Diagnostic and Statistical Manual of Mental
Disorders] is now the size of a phone book. More people are diagnosed
with depression than ever before. Are there really this many new
disorders? Or is this a social rather than a medical phenomenon?

One
way you can explain these increases is to look at the kind of
marketing done by the drug companies. But that's a little too
easy. If it were all a complete sham, you wouldn't see such a
huge increase in true problems -- in the United States, teen suicides
have tripled since 1960; we have twice as many obese kids as we
did 30 years ago. No one is making that stuff up.

Psychiatry
is part of the problem in that it is exploiting this situation,
but it is also diverting people from taking a true look at what
is happening in the culture to cause all of these problems. Our
society is perhaps the most economically successful culture in
the history of the world, materially. But in our one-dimensional
quest for productivity, consumption and efficiency, we have forgotten
about a whole bunch of things that people need to stay human --
like community, autonomy, diversity. All of those things have
shrunk.

Taken
together, this may help to explain why so many kids are being
diagnosed with attention deficit disorder and all these other
various childhood disorders. The largest increases we have seen
in new illnesses are the ones that affect children.

There
are real problems out there: You do have kids taking guns to school,
you do have people like Andrea Yates, you do have this huge increase
in people who think they are in pretty bad shape. But why is this
going on?

Is
it going on because more people have chemical imbalances? No.
It makes no sense to believe that human beings can change biologically
in one or two generations. Obviously, something else has changed
in our culture, in our society.

But
once you start looking at that, you have to start challenging
the assumptions of the status quo. And people at the top of society
don't want to do that. People who are at the top of institutional
hierarchies who are doing quite well don't want to look at that.
People on the streets have no problem with what I am saying. To
them, it just sounds like common sense.

In
general, you can either believe in numbing, or you can believe
in healing. It's very hard to do both. You can either believe
in grieving over losses, or you can believe in denying losses.
You can believe in people supporting and helping one another,
that you don't have to have a Ph.D. or an M.D., that if people
care about each other that they can provide emotional and physical
support better than any so-called authorities. Or you can believe
that unless you have a degree or expertise that you can't help
anybody.

Looking
at the history of drugs that have been marketed to women, it seems
that you can make an argument that psychiatrists and drug companies
are selecting for socially desirable traits. For example, in the
'50s, when women were supposed to stay at home, Valium was the
drug of choice. Today, the drug of choice is Prozac. Are we medicating
people to fit into society?

Back
in the '50s and '60s, they wanted docile women. So if any woman
was a little more upset or assertive than average, she would be
given librium or Valium. Nowadays, we want good little consumers,
we want good little workers. We don't want women to be docile;
we want them to be out there shopping and working. So we don't
want those old drugs anymore -- they make you sleepy, they make
you a little zoned out. But Prozac and Paxil seem perfect for
the new woman -- they just make you numb, but you can still shop
and work when you are on them.

Clearly,
I don't think it's desirable. Part of having a human society is
making room for all kinds of people. You don't chemically alter
them to make them fit in. And it doesn't work. But that is exactly
what they are trying to do -- especially to kids.

With
kids, it's really obvious. One hundred years ago, 6 percent of
kids graduated from high school. During World War II, it was about
25 percent. Almost nobody went to college. They worked on farms,
they worked as apprentices.

Today,
if you are a middle- to upper-middle-class parent and your kid
doesn't go to college, it means you are a failure as a parent.
I work with kids all the time. And some of the smartest kids I've
ever had don't belong in college at all. They just aren't academic
types. But when teachers come to parents and say, our kid is getting
C's and D's, and they aren't interested in Shakespeare, the parents
start freaking out and thinking that their child will never get
into college, and never get a job. We have created that. And that
is what we, as a culture, don't want to admit:

We've
created fewer and fewer places for different kinds of personalities
to feel good about themselves and to make a living.